Provider Demographics
NPI:1417096215
Name:BIRD, ERICA ELISABETH (MSPT, ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:ELISABETH
Last Name:BIRD
Suffix:
Gender:F
Credentials:MSPT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S LAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-5701
Mailing Address - Country:US
Mailing Address - Phone:386-456-0520
Mailing Address - Fax:
Practice Address - Street 1:1764 S WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7915
Practice Address - Country:US
Practice Address - Phone:386-734-9400
Practice Address - Fax:386-734-8866
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21834225100000X
FLAL18952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer